1.0 Introduction

1.1 Purpose

The "Annual State of NHSScotland Assets and Facilities Report for 2014" is the national strategic report on asset and facilities management for the Scottish Government and NHS Boards' and Special NHS Boards' use. Its purpose is to review asset and facilities management performance, highlight areas of best practice, set target areas for improvement and monitor performance against the targets. This is the fourth year that the report has been published.

The report will form part of the Scottish Government's formal performance review and investment planning process. It will inform the annual reviews of the Local Delivery plans (LDPs) through review of capital planning and infrastructure investment proposals. NHS Boards will be asked to use the performance framework set out in the report to demonstrate that assets are used efficiently, safely and support health care improvement. It will form the basis for setting target areas for improvement to be monitored by Scottish Government in partnership with Boards throughout the year. It will guide Capital Investment Group (CIG) investment approval decisions along with the Boards' annually updated and approved Property and Asset Management Strategies (PAMS).

The main body of the report provides key information and performance analysis on the full range of assets and facilities services covered by the scope of the report. More detailed information and analysis is provided in the Annexes to the report.

This year's report confirms continued improvement in performance in a number of areas and in particular, it identifies an improvement in the quality and comprehensiveness of the Property and Asset Management Strategies (PAMS) submitted by Boards. Generally, the PAMS show that Boards are increasingly linking their PAMS with service strategies - an essential requirement if investment in assets is to support the delivery of the Scottish Government's vision for the future.

1.2 Scope

The first report in 2011 focused primarily on NHSScotland property and estate issues. In 2012 the scope of the report was extended to cover all NHSScotland owned and leased physical assets (property, vehicles, medical equipment, and IM&T). In addition, from 2012 the report has examined a range of facilities management services that are closely linked to asset ownership. This widening of the scope of the report is aimed at understanding the opportunities for future investment across the different asset types. This is particularly important given the emerging landscape of new health & social care pathways which are increasingly being developed to deliver care outside of hospital environments. The 2013 Report introduced an analysis of office accommodation, differentiating it from clinical accommodation. This year's report further develops this theme, incorporating some of the outcomes from the detailed examination of office accommodation carried out through NHS Scotland's "Smarter Offices" Programme which was established in October 2013.

1.3 Policy

The strategic agenda for healthcare services in Scotland is set by The Healthcare Quality Strategy for NHSScotland. This is the overarching strategic context for the direction, development and delivery of all healthcare services for years to come both in terms of securing improvement in the quality of healthcare services, and in achieving the necessary efficiencies.

The Asset Management Policy for NHSScotland; CEL 35 (2010), establishes the policy environment and key performance indicators for asset management. It makes mandatory the use of the national asset management system to collect data and the requirement to submit annually updated asset management strategies to the Scottish Government. The policy establishes a robust framework against which the planning, delivery, management and disposal of property and other assets is undertaken and assessed. The policy seeks to establish asset management excellence in NHSScotland.

1.4 Context

Over recent years Scottish Government has carried out a number of key pieces of work which have set out the approach to improving quality in healthcare, a governance structure to align national work around the approach, the 2020 vision for what the healthcare system will look like in the future, and the strategic priority areas to deliver the vision for achieving sustainable quality in healthcare across Scotland. This work confirms the Scottish Government's commitment to providing care in a home or community setting with a focus on prevention and self-management and where hospital treatment is required for day case treatment to be the norm. This 2020 vision will have a significant impact on the type and distribution of assets and prioritisation of investment in the future.

The Quality Unit has worked with Cabinet Secretary and the NHS Boards to develop a route map to the 2020 vision for health and social care which identifies 12 priority areas for action in the three domains of the triple aim; quality of care, the health of the population and value and financial sustainability. It has been agreed that these form the basis for business planning, prioritisation, positioning and integration of all national work.

1.4.1 The 2020 Capital and Facilities Change Management Plan

The National 2020 Route Map identifies 12 priority areas which NHS Boards need to consider. A programme has been established to develop a 2020 Vision Route Map for Capital & Facilities to support implementation of the National 2020 Vision through the creation of a lean, more flexible estate and flexible assets that are responsive to care models and meet the future health and wellbeing needs of the population of Scotland. Within the context of developing and implementing change management activities and initiatives to support the opportunity to optimise the NHS Scotland assets, the following compelling vision helps to further link the Vision back to Capital and Facilities:

The National 2020 Vision is an exciting opportunity in Scotland to integrate Health & Social Care into a seamless person-centred system, to enable staff working in environments which are fit for purpose, and to deliver the highest quality safe care into the future. A route map is being developed as part of the programme established to develop a 2020 Vision Route Map for Capital & Facilities, aimed at supporting implementation of the National 2020 Vision, and which will form the basis for the development of a practical, user-friendly set of tools, templates and guidance material for Health Boards.

1.4.2 The Facilities and Shared Services Review

The Facilities and Shared Services Programme, established in 2011/12, is examining opportunities to improve efficiency and effectiveness through the development of strategic partnerships between Health Boards and, where appropriate, other public sector organisations. The areas of activity being examined are:

All outcomes from these work streams will be considered by the Facilities and Shared Services Programme Board before being passed to the Efficiency Portfolio Board for approval. Annex F provides an update on the current status of this review.

1.4.3 Capital Planning and Prioritisation

As with other areas of Government spend, capital resources for physical health assets are limited. It is therefore essential that those resources available are used to maximum effect. That requires a more formal approach to capital planning and prioritisation at NHS Board, regional, and national level. A Capital Planning and Prioritisation Short Life Working Group, which forms parts of the above Facilities and Shared Services Programme, has been established to take forward long term capital planning and prioritisation work to address capital constraints and fragmentation issues identified in previous State of NHSScotland Assets and Facilities Reports.

The Group's initial report concluded that the preferred strategy for delivering future capital planning services is one that is based on regional/geographic groupings of capital planning teams and resources. This proposed new strategy is expected to deliver significant benefits for NHSScotland.

The next stage for the CPSLWG is to prepare an Outline Business Case (OBC) for the regional model which will address the development of the preferred strategy, economic & financial appraisal, development of a risk register & management plan, and the development of an implementation plan. Further details of this review can be found in Annex D Capital Planning Review.

1.5 Procurement Efficiencies

The Scottish Government and Health Facilities Scotland procured a framework (Frameworks Scotland 2) for use by NHSScotland bodies to deliver cost and time efficiencies for publicly funded health and social care projects across Scotland. Frameworks Scotland 2 is now fully in use and reflects a strategic and flexible partnering approach to the procurement of publicly funded construction work and complements other procurement initiatives for the delivery of health, social care and other facilities in Scotland. It is expected to have a project "pipeline" of approximately £110m average per year.

Frameworks Scotland 2 provides a route for the procurement of publicly funded construction, repair and maintenance projects in respect of health, social care and other facilities. It sits alongside alternative procurement routes available, namely hub and NPD projects. The hub initiative is led by the Scottish Futures Trust on behalf of the Scottish Government and has been implemented across five geographical territories across Scotland. In each territory, the participating public bodies have joined with a private partner to form a new joint venture company known as a hubCo that will deliver a diverse pipeline of projects. Across Scotland the total value of projects delivered is expected to be worth more than £1.6bn over a 10 year period. Hub will typically be utilised for community services in particular primary care projects and health and social care projects involving multiple public sector organisations. NPD will be used to procure large projects which will be privately financed. The principal focus of the work under Frameworks Scotland 2 is anticipated to be around the acute sector, and will include both refurbishment and new build work along with programmes of backlog maintenance and risk reduction work. It is anticipated that the majority of the work will be projects or programmes of work with construction costs in excess of £1 million.

As part of the Review of Scottish Public Sector Procurement in Construction, the Scottish Government is leading on work streams and projects which relate to the development of the policy environment, with SFT leading those which are more about delivery on the ground, and Construction Scotland Industry Leadership Group (CSILG) delivering work streams around industry best practice.

1.6 Information Quality and Consistency

NHS Boards and Special NHS Boards have continued to improve the quality and consistency of information about the assets that they own and lease, including ensuring that this information is accurate and up to date. For example, a comprehensive programme of property appraisal surveys, supported and facilitated by Health Facilities Scotland, has been completed over the last 4+ years. As a result, most Boards are now reporting improved confidence in the quality and consistency of the property information that they submit for use in this report.

The extensive asset base covered by the scope of this report means that it has to gather a wide range of information from a number of different sources including:

The Estate and Assets Management System (EAMS)

Environmental Monitoring and Reporting Tool (eMART).

ISD Cost Book

Asset information Proformas provided annually by Boards for this report.

Boards, supported by HFS, have continued to improve the accuracy and consistency of the information held in these different systems, as well as gaining a better understanding of reasons for variation between the different information sources. An example of this improvement is the alignment of the data in EAMS and the 228 hospitals in the ISD Cost Book. In 2013 these facilities had a variance of 8.2% in recorded floor area. In 2014 this is now less than 1%. These improvements in data quality and consistency now provide a more robust basis for the performance analysis and monitoring presented in this report. Further actions will be taken to improve data consistency and robustness going forward.

The widening of the scope of this report in 2012 to cover vehicles, medical equipment and IM&T identified concerns on information quality for these assets. Boards have continued to work on improving the quality and consistency of data on these assets with improved confidence being noted, particularly towards information relating to medical equipment.